Abstract
TYPE: Abstract TOPIC: Allergy and Airway PURPOSE: COPD diagnosis is confirmed using FEV1/FVC and FEV1 which lack the sensitivity to detect early lung pathology. Here, small airway tests may be more sensitive than conventional spirometric measures to detect early disease. The aim of this study was to assess the presence of small airway dysfunction (SAD) as measured by MMEF, in symptomatic smokers with/ without spirometric airflow obstruction (AO). METHODS: Retrospective study of smokers who underwent Pulmonary Function Tests as part of putative COPD assessment between January 2016 and April 2021 in a secondary referral hospital in the United Kingdom. Patients aged >30 and pack-year history >10 were included. SAD was defined by MMEF <80% predicted and AO was defined as FEV1/FVC <70%. RESULTS: 1458 smokers were included and grouped into: group 1 (no SAD/ no AO, n=259); group 2 (SAD/ no AO, n=273); group 3 (SAD/AO, n=924). All patients with AO had evidence of SAD. Compared to group 1 and 2, patients in group 3 had significantly lower overall lung function (FEV1, FEV1/FVC, MMEF, MMEF/FVC, FEV3/FVC, [p<0.0005]). Patients in group 2 had significantly lower lung function than group 1 (FEV1, FVC, FEV1/FVC, MMEF, MMEF/FVC [p <0.0005], FEV3/FVC [p=0.002]. CONCLUSIONS: The findings show that low MMEF is a physiological feature in patients with established AO, as well as symptomatic patients without spirometric defined AO. This likely reflects early damage preceding development of classical spirometric AO. CLINICAL IMPLICATIONS: Early monitoring of symptomatic smokers with low MMEF may help determine developing AO enabling preventative measures to be implemented. DISCLOSURE: Nothing to declare. KEYWORD: Small airway dysfunction
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